Seattle—Considering that depression treatment often leads to weight gain, what is the best drug choice for patients who have depression but also are overweight or obese?

A study published recently in The Journal of Clinical Medicine suggests the answer is bupropion, marketed as Wellbutrin, which is the only antidepressant regularly linked to long-term modest weight loss.

The research was led by a study team from the Group Health Research Institute in Seattle that previously had demonstrated a direct relationship between depression and body weight, i.e., that patients with depression were more likely to be overweight and vice versa.

Noting that past research on antidepressants and weight change usually has been limited to one year or less, study authors point out that antidepressants often are used for longer than a year. As a result, they conducted a 2-year study, following more than 5,000 Group Health patients who started taking an antidepressant.

“Our study suggests that bupropion is the best initial choice of antidepressant for the vast majority of Americans who have depression and are overweight or obese,” explained study leader David Arterburn, MD, MPH, a senior investigator at Group Health and an affiliate associate professor in the University of Washington School of Medicine. “We found that bupropion is the only antidepressant that tends to be linked to weight loss over two years. All other antidepressants are linked to varying degrees of weight gain.”

Bupropion might not be appropriate in all cases where the patient has a weight problem, Arterburn added, noting that a history of seizure disorder is a contraindication.

By the end of the 2-year study, nonsmokers had lost an average of 2.4 pounds on bupropion compared with gaining an average of 4.6 pounds on fluoxetine, marketed as Prozac, according to the results.

The same variance wasn’t identified in patients who smoked, however. Study authors explain that bupropion is often used to help patients stop smoking and smokers often have a weight gain while quitting.

“A large body of evidence indicates no difference in how effectively the newer antidepressants improve people's moods,” coauthor Gregory Simon, MD, MPH, added in a Group Health press release. “So it makes sense for doctors and patients to choose antidepressants on the basis of their side effects, costs, and patients' preferences--and, now, on whether patients are overweight or obese.”